tv Senate Health Panel on Opioid Crisis Part 1 CSPAN October 5, 2017 8:02pm-8:34pm EDT
the senate committee on health education, labor and pensions will please come to order. today's hearing is about the opioid crisis and what the federal government is doing about it. senator murray will each have an opening statements and then the witnesses and after the witness's testimony, senators will each have five minutes of questions. the senate has inefficiently scheduled three votes starting now and all of us would like to hear the witnesses' testimony so
we'll figgiure out what to do about that. the opioid crisis is tearing our communities apart. tearing families apart and posing an enormous challienge t health care providers. the amount of opioids prescribed in 2015 was enough for every american to be medicated around the clock for three weeks. according to the centers for disease control and prevention. in 2016 there were over 7.6 million opioid preskripgcriptior pain in tennessee. that means for every 1,000 persons. in march researchers published a study that found nearly 1 in 5 patients prescribed an additional 10-day supply were found to still be using opioids
a year later. last year 1631 tennessees dies of an over dose, 12% more than the year before, mostly due to an increase in opioids, like fentanyl, stronger than morphine and blount county where i live in tennessee, 20 people died in 2016 alone from an opioid over dose. last year was the highest level of deaths over doses in our state ever recorded. last year over 1,000 babies born in tennessee were born addicted to opioids. the rate of tennesseeens being prescribed opioids is one of the highest in the country. this is a crisis, not just in tennessee but across the country. since 1999, the rate of over dose deaths involving opioids including prescription drugs and
heroin has nearly quadrupled. 91 americans die every year from an opioid over dose. i hope today's distinguished panel of witnesses can give an update on the federal response to the crisis. what's working and what needs work. this committee has worked together to pass laws that help prevent addiction and curage appropriate, prescribing and approved treatment. in july 2016, the comprehensive recovery act was signed into law. this legislation established new programs and authorities. we authorized existing ones and encourage law enforcement, public health departments to work together to combat substance abuse. a few weeks ago the administration announced that under kara, 134 million in grants will be awarded to 58 recipients. including community organizations. tennessee will receive 6
million. endecember of 2016 as part of the 21st century act, we work together to update drug abuse programs out of the substance abuse and mental health servicesed a min strasservices ed a madministration and provid billion for prevention and treatment efforts. they began grants totaling 485 million to all 50 states. tennessee received nearly 14 million of that. the most ambitious goal was to drive it research discoveries predicted over the next decade by one of our witnesses today, dr. frances collins. the dr. of the national institutes of health, which he calls the national institutes of hope. he has predicted the development of an artificial pankrious, grown from patient's own skin cells, and nonaddictive pain killers. nonaddictive ways to treat pain could be medical devices or
drugs. while there is an urgent need for this, it is not at all a new idea. in 1928 what became known as the committee on drug dependence, formed pursuit of a nonadilktive pain killer. we all know the importance of dealing with pain. we were having a conversation just before the hearing. one report according to collins says 25 million americans live with pain every day so this is not to minimize the number of americans who need some form of help relieving pain. i want to hear today about the public, private partnership that the national institutes of health is leading and what to do to make sure the opioids are
prioritized appropriately and get -- i've heard people who have prod lucts in pain and development. i want to make sure they have guidance to review in a timely way. if traditional priority to know what the fda may need. monitoring programs. subsidies prescribed by doctors and dispensed are an important and innovative tool. i look forward to hearing how we can help states better integrate prescription drug monitoring programs with electronic health records to protect patient privacy. congress has accomplished a lot in a bipartisan way to update programs to assist states and help combat this public health
crisis. i look forward to hearing how the administration is moving forward. senator murray. >> well, thank you very much, chairman, alexander and thank you to all the colleagues for coming together for the truly urgent discussion. from every corner of our country we hear more about the damage being caused by the opioid crisis, lives being taken off track, mothers and dads who worry about late-night calls or what it means if no call comes through. children who lost parents, emergency services overwhelmed. it is hard to grasp the full scope and scale of this crisis, even as we learn more. i was in a small town in my state. i was told nearly 50% of all babies born there last year have mothers with substance abuse. that was just overwhelming and heart breaking. and it speaks to what i've heard from all over my state in every community from big communityies
and vancouver, everywhere i go. same thing from law enforcement professionals. so this is not somebody else's problem. it's all of ours and that's why i'm very glad we have this opportunity to discuss this and hear from leaders about what they are seeing in each of their roles so thank you for joining us today. i'm glad you could all be here. so i'm concerned dr. fitzgerald hasn't sufficiently divested to testify in such an important issue. because we need cdc to be full strength and not subject to distractions plaguing this administration. your agencies play a critical role and i know we're looking forward to hearing how this administration is stepping up and falling behind and that means on implementation of the
addiction and recovery act and the 21st century cures act. i will have specific questions for all of you, including how samsa is insuring federal funds are being used to help people in all of our communities. what steps cdc can take to prevent opioid misuse in the first place. working to promote biomedical research and how fda is working to include public health considerations when it approves new pain products and assuring nonaddictive pain products are being handled with clarity and consistency and all-hands on deck approach. but i want to make a couple of poij points. today's hearing is only possible because the latest trump care bill met a dead end. because undercutting the entirety of the health care system would set us back in addressing this crisis and what we've seen from every repeal
bill is drastic cuts to medicaid and crucial protections today provided under current law. i hope we can finally turn a page on those fights and focus on moving forward and on that i am very appreciative of the bipartisanship many have shown in our ongoing work on the market stablization. now another step is making sure we're doing everything we can right now to fight this crisis head on and i do have several concerned. the administration has delayed critical steps that can help provided immediate relief, proposing budget cuts around substance use disorder and mental health programs under samsa. in effectively managing opioid use disorders and pushing the department of justice to treat addiction as a criminal justice issue. fortunately we made progress in
this committee. like everyone here i'm very proud to have worked on the 21st century cure's act. through prevention and treatment and recovery efforts and the kara act which supports outreach for veterans and post pardm women. but i can't say clearly enough. our work is not over and we must do more. as we work to build upon our work in kara and cures, it's absolutely critical that we put investments into making sure they have the impact communities need. we should be doing everything we can to tackle this crisis and push for actual results and critical to that is the administration is a partner and not a hindrance to our efforts. we have lot to cover and i'm very much looking forward to our conversation and i know lot of our senators are juggling a lot of commitments today, including votes which have just started.
and many other hearings. so i want to make sure we include a statement from senator sanders and anybody else before we move to question. >> we will be glad to do that. and i'm going to offer a brief introductions of our witnesses and hope we can hear all four of them before i have to leave to go vote and then we'll see how to handle the three votes. first, dr. mccann cats is the secretary for the mental health abuse. samsa is the lead agency related to substance abuse and mental health. dr. deborah houry, the centers for disease control and prevention. dr. frances collins, director of the national institutes of health since 2009. and dr. scott got leave who's commissioner of the food and drug administration confirmed in
may of this year. dr. mccann's why don't we begin with you and ask each of you to sums are your comments in about five minutes. >> thank you, senator alexander. thank you for inviting me to testify at this important hearing. i'm honored to testify along with my colleagues from the department of health and human services on the federal response to the opioid crisis. over the past 15 years communities across our nation have been devastated by increasing prescription and elicit opioid abuse and addiction over dose. in 2016 over 11 million americans misuse prescription opioids. and 2.1 million had an opioid use disorder due to opioids. most alarming is the continued increase, especially the rapid increase in deaths involving elicitly made fentanyl and other
synthet synthetic opioids. the department of health and human services has defined five specific strategies. this strategy aims to improve access to treatment and recovery services to prevent the social, health and economic consequences associated with opioid addiction. and target the availability and distribution of over dose reversing drugs to insure the broad provisions to those likely to experience an over dose. to improve the timelylyness and inform a real time public health response as the epidemic resolves. leads to the development of new treatments and identifies effective public health interventions tootoo reduce
health harms and to enable access to high quality, evidence basised pain care. families and society while also reducing the inappropriate use of opioids and opioid related harms. hhs appreciated congress pfsz dedication to this issue, as evidence by passage of the 21st century cures act and the comprehensive addiction and recovery act. in my role as assistant secretary, i lead the mental health services administration. i appreciate the opportunity to share with you a portion of samsung's portfolios in alignment with the five strategies and how samsung is implementing the act. they're administering the opioid state targeted response grants program. by providing $485 million to states and fiscal year 2017. this program is increasing access to treatment, reducing
unmet treatment need and opioid related deaths through the provision of recovery services. further it's working to insure policies are as clinically sound, evidence based, effective and efficient as they can be. samsa has several initiatives for opioid use disorder. in the past four years more than 62,000 medical professionals have participated in online or in person trainings for opioid use disorders. they regulate opioid treatment frograms and provides wavers for the treatment of opioid addiction. last year they published a final rule for physicians for up to 100 patients. to obtain a waver to treat up to 275 patients. 273 physicians have done so. they have implemented the
provision that allow them to provide the drug. 2,saerv nurse practitioners have received a waver. they promote recovery through targeted grants such as last month 's 4.6 million. over three years in the grant program created by kara. it's been a leader to reduce the avail nlt to reduce over dose. samsa is currently reducing opioid over dose related deaths which is being used to purchase and distribute. last month samsa awarded additional grants including over five years to grantees in 22 states to provide resources to first responders as well as substance use treatment providers.
states can also use opioid str grants to purchase and distribute it and some are using a portion of their block grants for this purpose. it has a including opioid misuse. it's a vital use of the surveillance effort and the dayligdata has been used to track trends including demographic varability and works to understand the epidemic through sharing of data. thank you again for the opportunity to share with you our work to combat the opioid epidemic and look forward to answering your questions. >> i'm going to stay through the four witnesses' statements and then go vote. >> will they hold the first vote? >> i'm going to make sure i get there in time to vote.
so if you want to stay through that, we won't miss the vote, if you leave when i leave or you can fire me if i'm wrong. so dr. houry. >> good morning, chairman, alexander, ranking member murray and members of the committee. director of the national senter for injury prevention and control at the cdc. as an emergency physician i was honored to join cdc three years ago to save even more lives in this role. i'm pleased to have the opportunity to testify before you today. cdc's expertise as the nation's public health and prevention agency is essential. cdc is focussed on preventing people from getting addicted in the first place. they have the unique role by addressing opioid prescribing, tracking trends and driving community based prevention activities. america's opioid over dose
epidemic effects people from every community and it is one of the few public health problems getting worse instead of better. drug over doses have dramatically increased, nearly tripling over the last two deck aitd aides. further, it's led to a number of other problems, including decreases in babies born and a drop in life expectancy for the first time since the aids epidemic. but today's over dose fatalities are just the tip of the iceberg. for every one person who dies of an opioid over dose, over 60 more are already addicted to prescription opioids, almost 400 misuse them and nearly 3,000 have taken one. using a comprehensive approach as outlined in the hhs priorities u we will work together to stop this epidemic. cdc has been on the frontlines since the beginning.
over a decade ago after hearing alarming news about increases in over dose deaths and after an outbreak investigation, cdc scientists made the connection to prescription opioids. we're working closely in providing guidance so states can rapidly adapt and we can use what we learn, what works best in this evolving epidemic. cdc now funds 45 states in washington d.c. to advance prevention in key areas that community level, including prescription drug monitoring programs, improving prescribing practices. in georgia where i've worked in the er, these investments help make it easier to check the prescription history of my patients. and to alert of high doses which resulted in a 25% reduction of opioid prescribing to youth.
these investments can literally save lives. cdc is also leading improvements to the public health data we all rely on to understand the crisis. we are now releasing preliminary over dose data and improved reporting significantly from a lag of two years down to seven months. as part of cdc pfsz funding to states we're ramping up our efforts to get more timely data through inhandlesenhanced surve program. this tracks nonfatal opioid over doses so we have a better understanding so states can respond accordingly. this is the value of informed and nimble public health. they rely on cdc to provide on the ground assistance. we help massachusetts identify that a surge in opioid deaths was caused by fentanyl and we assisted indiana to identify and
contain a hiv and hepatitis c outbreak related to prescription opioids. we truly appreciate the support we receive from this committedy for our guideline to prescribing opioids for chronic pain whichry we received last year. now we're working on making it easy to implement through a mobile app. we're also focusing on patients and families. just last week cdc released the awareness campaign to raise awareness about the risks of prescription opioids. the campaign features real-life accounts of people living in recovery and those who have lost someone to an over dose. cdc's unique approach to surveillance and prevention are key in reducing the opioid ep m epiem epiemepie epidemic. and to saving the lives of those touched by this epidemic.
thank you forio urtime and i'm happy to answer any questions you might have. >> thank you. good morning, mr. chairman and ranking members of this committee. my colleagues have given you a vivid picture of the vast scope of the opioid epidemic. i'd like to take a personal face on this crisis. americans like a young manual rr call jeff. when this 29-year-old alaska native returned from serving in the war in afghanistan. he experienced a series of personal crisis. he got hooked on cheap heroin and eventually ended up homeless on the streets of seattle. de desperate to escape the spiral, he sought help. he turned to researchers at the va in seattle and they enrolled him in a new protocol. but unlike traditional treatment
programs, jeff was started on oral buf norfein immediately. the results, he stopped using heroin right away. but still sometimes experienced strong cravings for opioids. so researchers adjusted his treatment, giving him an additional evidence based to bring those under control i'm thrilled to tell you he has not usesed heroin for several months, not homeless and holding down a regular job. i don't want to give the impression his story is typical or easy. many have different stories and they need different interventions but it does show how research can provide a wider array of options. addiction is a powerful force, driven by the way opioids can rewire the brain. when people suffering from addiction seek help, we owe it to them.
research can help us get there. there currently are three fda approved medications for opioid use disortder. but relapse rates are way too high. and more options are needed to end this epidemic. we need to understand which individuals succeed on which medicine over what doses over what time period, combined with what kind of psycho social support. they have a successful record to develop some of these new treatments and interventions. for example many communities have enabled their first responders to reduce opioid over doses. in partnership with industry, they developed this nasal spray. that was by the way just dist iled water in case everybody's worried about me using an
ineproep ret substance in the hearing room. it's now the most widely used ant dote for over dose. just last week, following a series of no less than seven action oriented meetings since april, they provided more than 50 companies to explore a research partnership. first, to expand medication options to treat addiction as well as to reverse over dose in the face of more deadly opioids like fentanyl and carfentanil. the second is to develop potent, nonaddictive medications for pain. we must find better ways to help those 25 million americans who suffer from pain on a daily basis. the developing partnership will build on basic science insights opening avenues for nonaddictive drugs. for example, we once thought the brain's pain and reward systems
were inextricably intertwined but when we learned they bind to an opioid receptor, they can open new pathways, pain and reward. they can provide the pain relief, without activating the reward system that leads to addiction. other potential targets have been identified through studies of neuroscience. one promising drug target has been identified by studying rare individuals born with genetic insensitivity to pain. the partnership will also seek to determine whether agents that reduce inflammation can provide potent pain relief. and that's not all. we're working with industry to explore ways to get bio markers and likely responses to intervention.
and we'll explore the creation of a new clinical trial effort for promising new therapies and facilitate the sharing of such data. we do need all hands on deck. my fellow colleagues, academic researchers, advocates for pain research and last but certainly not least, we need you, members of congress. your support is essential to stop end this terrible epidemic ending so many american lives. thank you for ending this hearing today. >> thank you. we're 75% complete. i'm going to recess the hearing for about 20 minutes so they ask us to come vote because of the budget committee's meetings, etc. we'd like to hear your testimony so we're going to recess for 20 minutes, vote twice. and then come back and we'll hear you and begin questions.